Acid Reflux

Acid Reflux refers to flow of stomach juices into the esophagus. While the periodic presence of the stomach’s liquid contents in the esophagus is normal, the amount of these juices, their acidity, and the frequency with which this reflux takes place can often become excessive.  The result can be creates irritation of the lining of esophagus.

At the juncture of the stomach and esophagus is a sphincter muscle that closes to prevent too much of the acidic liquid in the stomach from entering the esophagus. Sometimes this reflex for closing off the upward movement of stomach acid functions poorly (and the valve opens at inappropriate times) or the contents of the stomach become to acidic, or both, resulting in a sensation of burning in the chest or throat.

When the condition is chronic, it often referred to as GERD (gastroesophageal reflux disease). Regular or serious reflux can also affect the throat (pharynx, causing sore throat) and even the voice box (larynx, causing hoarseness). In severe cases it can lead to significant complications, such as inflammation, ulcers, strictures, pre-cancerous tissue changes, chronic cough, or other problems.

If the acid damages the cells on the lining of the esophagus, these cells can become abnormal, causing a condition called Barrett’s esophagus. The cells loose their pink coloration and gradually take on a reddened appearance, as they become, microscopically, more like the cells within the stomach. Only a minority of people with GERD has the condition long enough and severely enough to develop Barrett’s. And, of those who do, only small portion (less than one percent) will go on to develop cancer of the esophagus as a result.

Causes/risk factors

Reflux disease affects tens of millions of people in the U.S. with varying degrees of severity. It is not know for certain why some people are more disposed to high stomach acidity or retrograde flow of peptic juices. A few risk factors are known:

• age. The development of at least mild, and sometimes severe, reflux starting in the 30s, 40s, or 50s is common, in part as the pyloric sphincter valve loses conditioning.
  
  
• diet and lifestyle. Many types of foods and spices, as well eating patterns and habits can contribute to acid reflux.
  
  
• pregnancy. Reflux is more common in women during pregnancy, presumably due (at least in part) to changes in pressure within the abdomen.
  
  
• weakened esophageal muscles. Certain neurological and other conditions can weaken the valve-like function of the top of the stomach and bottom of the esophagus.
  
  
• hiatal hernia.
  
  
• and smoking. Smoking can increase the acidity of stomach contents.
  
  

Signs & symptoms

The primary manifestations of acid reflux are:

• frequent and persistent heartburn (burning sensation in the esophagus or deep in the throat, often after eating);
  
  
• backflow of acidic stomach contents or a sensation of regurgitating stomach contents into the esophagus (sometimes leaving a sour or bitter taste in the mouth);
  
  
• difficult or painful swallowing;
  
  
• change in voice quality;
  
  
• and discomfort or poor sleep at night;
  
  

Diagnosis

History of the symptoms and observation of their response to noninvasive treatments such as antacid medications are the best indicators of reflux disease. In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose ulcers:

• upper endoscopy;
  
  
• 24-48 hour measurement of the degree of acidity in the esophagus (via tiny sensing devices placed in the esophagus);
  
  
• esophageal motility testing, gastric emptying studies, or acid perfusion tests;
  
  
• CT scan.
  
  

Treatment

Treatment for acid reflux falls into three main areas:

• diet and lifestyle. Patients can identify foods that trigger reflux and can eliminate them from their diets. They may also learn to change other habits, such as eating smaller amounts, avoiding fried and fatty foods, losing weight (to take pressure off the stomach), not eating within three hours of bedtime, elevating the head of their beds, avoiding physical activity after eating, avoiding clothes that fit tightly around the stomach, and stopping smoking. Stress reduction can also play a roll for some patients.
  
  
• medications. Over-the-counter and prescription antacids or acid-controlling drugs are the most widely used class of medications in the U.S., other than analgesics. Conventional over-the-counter antacids can be useful for occasional, situational reflux. People who suffer from chronic reflux disease, may use one of the newer or stronger classes of agents by prescription of OTC. These drugs, which have proven safe for long-term use, include H2-blockers (to reduce the amount of acid in the stomach by blocking histamine, a powerful stimulant of acid secretion) and proton-pump inhibitors (to more completely block stomach acid production by stopping the stomach's acid pump, the final step of acid secretion).
  
  
• surgery. Surgery to restructure and tighten the area where the esophagus enters the stomach is effective. Specialists can use a laparoscope to perform this operation endoscopically, with minimal invasiveness. Some patients, however, experience recurrence of reflux some years after such an operation. Patients with significant damage to the esophagus or stomach, related to reflux, may need more extensive forms of surgical treatment, such as those offered in Frankford's Division of General Surgery.